In Honduras, an MSF team member conducts a health survey on the streets of the capital.

Kate Mort is an MSF-USA Field Human Resources Officer.

National staff is crucial to every MSF project; they are at the core of everything we do. National staff makes up around 90 percent of all MSF field workers, so they do most of the nuts-and-bolts work that keeps our projects running.

Generalizing is hard, because every situation is different. For example, South Sudan is a very challenging place to find people with the necessary training and expertise. I’ve worked in South Sudan a few times, most recently in 2012. The population has had very limited access to education because of decades of war. There simply aren’t many medically qualified people. In many projects in South Sudan, we train the staff ourselves— which also means we have to send more international staff to work in those projects.

India is on the other end of the spectrum, a place where there is a very high level of medical training and national staff tend to be very capable right off the bat, so they hold higher-level positions. The only difficulty is finding people who are comfortable working in conflict zones, where some of our projects are. They can work in a nice hospital, so why would they want to go to Chhattisgarh, a dangerous place in the middle of nowhere? That means that the international doctors that work in India tend to hold supervisory and clinical advisor positions, rather than doing more hands-on medicine, as they do in South Sudan.

With staffing, it’s all about context. And the individual. When I was in South Sudan in 2004, there was an enormously enthusiastic, motivated, and intelligent guy who started as a cleaner. Over the years, he was promoted to working in the pharmacy, working on pharmacy management, working with dispensing medication and patient care. Eventually, he became a medical officer.

We certainly try to encourage professional development. There are various trainings available to national staff within MSF, and we do more trainings in the field now. We also send people from different projects to trainings all over the world, which is great, because now we have a lot more national staff moving into higher levels of management and many who go on to work for us as expatriates themselves.